Are there optimal alanine aminotransferase and HBV DNA thresholds for discriminating HBeAg-positive chronic infection from chronic hepatitis? : An evaluation of 215 young and male cases

OBJECTIVES: To define the importance of biochemical and virological thresholds for the prediction of significant liver diseases. METHODS: A total of 215 young and male HBeAg-positive cases followed up in a tertiary training and research hospital in Turkey between 2008 and 2017 enrolled in the retrospective diagnostic accuracy study. RESULTS: Fibrosis scores varied between 0-4, F1 (n=81, 37.6%) and F2 (n=82, 38.1%) were the most frequent fibrosis stages. Of the patients, 58.6% (126/215) had a significant histopathological abnormality (SHA). The ratio of SHA was higher for ALT >90 U/L (n=68/95; 71.6%) and HBV-DNA between 2,000,000-200,000,000 IU/mL (n=47/73; 64.4%). Thresholds for the higher odds ratio (OR) for SHA were >90 U/L for alanine aminotransferase (ALT) and >2,000,000 IU/mL for HBV-DNA. Based on receiver operating characteristic analysis, 90.5 U/L of ALT and 22,607,500 IU/mL of HBV-DNA were levels with the optimum sensitivity and specificity for the prediction of SHA. CONCLUSION: Hepatitis B virus-DNA levels between 10(6) and 10(8) IU/mL and ALT levels of 2~3 x ULN might be considered to be good indicators for discriminating chronic hepatitis phase from chronic infection in hepatitis B e-antigen-positive chronic hepatitis. However, we think that the current biochemical, serological and molecular markers are inadequate for differentiating chronic hepatitis phase than chronic infection, and non-invasive test and/or liver histopathology should be carried out in selected cases.